Korelacija nalaza kalcificiranih arterija dojki s aterosklerotskim promjenama karotidnih arterija [Correlation between breast arterial calcifications and atherosclerotic changes of carotid arteries]

Kosović, Vilma (2015) Korelacija nalaza kalcificiranih arterija dojki s aterosklerotskim promjenama karotidnih arterija [Correlation between breast arterial calcifications and atherosclerotic changes of carotid arteries]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Cerebrovascular diseases in all its forms according to the frequency and the high percentage of lethality and mortality are at the very top of the problems of modern medicine. The goal of modern medical science is the prevention of cerebrovascular disease . In this research breast arterial calcifications in mammograms were detected predominantly within The National programme of early detection of breast cancer in Croatia which has been implemented in the Republic of Croatia since 2006. The aim of the research was to investigate a connection between calcified arteries on breast mammograms and atherosclerotic changes in the carotid arteries. The second objective was to determine the association of certain risk factors : age , smoking, diabetes, hypertension and hyperlipidemia, BMI, peripheral artery disease, atrial fibrillation, oral contraceptives and previous stroke /TIA/RIND/IM with the degree of intramammary arterial calcifications on mammograms. The study aimed to assess the importance of mammography findings of breast arterial calcifications (finding to which attention was not paid in everyday diagnosis ) as an important indicator for the presence of atherosclerotic changes in the carotid arteries, and thus contribute to the early detection of the risk for cerebrovascular disease. This was a prospective study that included 300 women aged 47-69 years. Breast arterial calcifications were found in mammograms of 149 women while the control group consisted of 151 women without breast arterial calcifications in mammograms . The hypothesis of the study was : 1. Mammographic finding of breast arterial calcifications represents an increased risk for the existence of atherosclerotic changes of the carotid arteries, which are a significant risk factor for cerebrovascular disease. 2. The degree of breast arterial calcification is correlated with the degree of atherosclerotic changes in the carotid artery and carotid artery stenosis assessed by ultrasound. 3. The occurrence of breast arterial calcification is associated with age, smoking, elevated blood glucose, high blood pressure, lipids, BMI (body mass index ), peripheral artery disease , previous stroke / TIA / RIND / MI , atrial fibrillation , taking oral contraceptives, hormon replacement therapy . All patients were included in mammography and Doppler ultrasound of carotid arteries with the risk factor anlaysis. During the analysis of mammograms two independent radiologists recorded breast arterial calcifications and based on their visual assessement classified them according to the degree of intensity in two stages: 1. First degree indicates gentle arterial calcifications 2. Second degree indicates intense arterial calcifications In order to assess the presence and degree of stenosis duplex Doppler ultrasound with spectral flow quantification was done. The common carotid artery ( CCA) throughout the course , in the transverse and longitudinal sections was examined , then the bifurcation and the internal carotid artery (ICA) and external carotid artery (AC ). Stenoses were diagnosed by consensus on performing Doppler ultrasound adopted by a group of experts under the auspices of the Society of Radiologists in ultrasound in San Francisco ( USA ) in the year of 2002 . Assessment of atherosclerotic lesions of the carotid arteries was performed in four stages: O. level - normal Doppler ultrasound of the carotid arteries 1. degree - mild atherosclerotic changes in terms of wall thickening and ACI initial small plaque 2. degree - moderate atherosclerotic changes in terms of larger plaques and stenosis of up to 50 % 3. degree - advanced atherosclerotic changes in terms of stenosis over 50 % All subjects underwent blood test analysis with attention to the risk factors for atherosclerosis ( triglycerides, cholesterol, glucose ) . The results were statistically analyzed and presented numerically and in tables . In this study, the average age of subjects was 61.95 ± 6.41 years , range 47-69 years. Groups of patients were compared by age and with regard to the result of mammography by age and the resulting variable whose averages are statistically significantly different in groups was based on statistical analysis. Insight into the mean age in groups, it is evident that there is a correlation between the findings of the age group of subjects with an intense calcification and atherosclerotic changes in the carotid artery ( F = 5.494 , p < .05 ) . The above tabular and graphical data indicate a slight, statistically significant correlation between mammography findings with mild calcified arteries and changes in circulation disorder of the carotid arteries on Doppler test ( τ = ,149 , p < 0.05 ). With the increasing arterial calcification on mammography the result of Dopler test is increasing to some extent. This connection is manifested in mild percent reduction proper findings and a slight increase of stenosis on Doppler test with increasing calcifications on mammography. It can be determined that there is a statistically significant correlation between the results of intensive calcifications on mammography and the results of the Doppler test based on the data from the table and graphic display and the resulting chi-square test ( χ2 = 8.242 , p < 0.05 ). There is less proportion of patients with a normal Doppler and a greater proportion of those with stenosis ( especially stenoses < 50 % ) in the group with intense breast arterial calcifications. In the research all respondents underwent blood tests with an analysis of known risk factors for cerebrovascular disease including: cholesterol, triglycerides and glucose . The average blood glucose value was 6 ± 1.75 mmol / L , with a range from 4 to 25.95 mmol / L. The average amount of cholesterol in the blood was 5.37 ± 0.94 mmol / L , with a range from 3.94 to 8.8 mmol / L. The average value of triglycerides in the blood was 1.45 ± 0.5 mmol / L with a range of 0.74 to 4.23 mmol / L. There is no statistically significant correlation between breast arterial calcifications and these risk factors. History data related to cerebrovascular disease risk factors: smoking, alcohol consumption, data about previous use of oral contraceptives and taking hormone replacement therapy , hypertension , a prior morbidity from cardiovascular disease and peripheral arterial disease , BMI, atrial fibrillation were obtained from the respondents. Smoking is the only one variable of the three observed variables( smoking, hypertension, taking oral contraceptives) that is not allocated equally by both groups of respondents compared to mammography ( χ2 = 9.450 , p < 0.05 ) . In the group with gentle(mild) calcification is the highest proportion of smokers ( 28.9 %) compared to the group without calcification (14.6 %) or the group with intense calcification (12.1 %) . It is evident that the index of smoking was 0.33, for alcohol consumption 0.006 and 0.33 for hypertension. Also low indices were for body mass index, hormone replacement therapy, atrial fibrillation, peripheral arterial disease and the number of births . The results of this study confirmed a statistically high correlation between the intensive breast arterial calcifications and the presence of atherosclerotic changes in the carotid arteries. Mammographic finding of intense calcifications is a significant predictor of a positive result on Doppler or subjects with intense calcifications are 3,037 times more likely to have thickening of the carotid wall or stenosis. The results showed small statistically significant correlation with age and also with taking oral contraceptives. The probability of an increase in breast artery calcification slightly increases with age. Also, women taking oral contraceptives have a higher level of calcified breasts arteries.

Abstract in Croatian

Ciljevi provedenog istraživanja bili su: istražiti povezanost kalcificiranih arterija dojki na mamogramu i njihovog stupnja, s aterosklerotskim promjenama i njihovim stupnjem u karotidnim arterijama, odrediti povezanost određenih rizičnih čimbenika: dob, pušenje, dijabetes, hipertenzija i hiperlipidemija, BMI, periferna arterijska bolest, fibrilacija atrija, oralni kontraceptivi, te prethodni CVI/TIA/RIND/ sa stupnjem kalcifikacija intramamarnih arterija na mamogramu, i dokazati značaj mamografskog nalaza kalcificiranih arterija dojki kao važnog pokazatelja za postojanje aterosklerotskih promjena karotidnih arterija, te tako pridonijeti ranom otkrivanju rizika za cerebrovaskularnu bolest. U ovom istraživanju je uključeno 300 ispitanica koje su razvrstane u dvije skupine: ispitivana skupina sa 149 ispitanica s arterijskim kalcifikacijama dojki na mamogramu, i kontrolna skupina sa 151 ispitanicom bez arterijskih kalcifikacija dojki na mamogramu. U ispitivanoj grupi su dvije podgrupe ispitanica - ispitanice s nježnim i ispitanice s intenzivnim kalcifikacijama. Svim ispitanicama učinjen je Dopler karotida, uzeti su anamnestički podaci i učinjene su laboratorijske pretrage. Istraživanje je, temeljem statističke obrade, pokazalo statistički značajnu povezanost kalcificiranih arterija dojki na mamografiji, i stupanj ateroskleroze karotidnih arterija na ultrazvučnom Dopler testu kod ispitivanih. Obradom je utvrđena statistički značajna povezanost nalaza srednje intezivnih kalcificiranih arterija dojki i uzimanja oralne kontracepcije, te dobi ispitanica. Statistički nema značajne povezanosti arterijskih kalcifikacija dojki s rizičnim čimbenicima u krvi (kolesterol, trigliceridi, glukoza), pušenjem, konzumacijom alkohola, kardiovaskularnim bolestima i BMI. Dobiveni rezultati ovog ispitivanja su potvrdili statistički visoku korelaciju između grupe intenzivnih kalcifikacija arterija dojki i postojanja aterosklerotskih promjena u karotidnim arterijama. Logističkom regresijom utvrđeno je da je nalaz intenzivnih kalcifikacija značajan prediktor pozitivnog rezultata na Dopleru. Ispitivanjem je potvrđena hipoteza, da nazočnost kalcificiranih stijenki arterija dojke na mamografskom pregledu, upućuje na veću vjerojatnost aterosklerotičnih promjena stijenki karotidnih arterija. Mamografski nalaz kalcificiranih stijenki arterija dojki predstavlja povećan rizik za postojanje aterosklerotskih promjena karotidnih arterija, koje su značajan čimbenik rizika cerebrovaskularne bolesti.

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